The recent controversy regarding over treatment of prostate cancer, and the questioning regarding the usefulness of routine PSA testing is causing even more confusion in an
already confusing, and heavily nuanced, disease. While there is undoubtably over treatment occurring because of the non specificity of the PSA test, as well as the tendency for both patients and physicians to opt for an aggressive approach to dealing with prostate cancer, it’s not clear that “watchful waiting” is likely to always be as effective or harmless. The link below, for an article in the 11/15/2011 issue of the New York Times, outlines one NY physicians approach to “active surveillance”. Unfortunately, while some of the dietary suggestions may or may not be helpful, and likely are for the most part harmless, recommending serial biopsies or an invasive, frequently imprecise and questionable procedure such as cryosurgery in an 85 year old may not be, in my opinion, as effective and harmless as early and definitive noninvasive treatments, such as prostate stereotactic body radiosurgery (SBRT) with the cyberknife.
What is really necessary, is the realization that PSA is a test that must be interpreted in light of multiple other factors, and is not, in itself definitive. We should be careful not to abandon screening and definitive treatment too quickly, rather that learning how to more carefully interpret PSA and other screening information in the most effective and safe way for each individual patient.
James G Schwade MD FACR FACRO FASTRO
Executive Director,
Cyberknife Centers of Miami & Palm Beach